Peru healthcare

Peru unveils plan to reform social health insurance

October 4th 2018 | Peru | Spending

A government commission will publish guidelines to strengthen the role of EsSalud, the public health insurance system.

On September 26th 2018 Peru's Ministry of Labour and Employment Promotion (MTPE) announced a plan to improve the country's Social Health Insurance, EsSalud. The government will set up a sectoral commission that will recommend changes for the EsSalud, working in collaboration with the International Labour Organization (ILO) and the Pan American Health Organization (PAHO). The sectoral commission will present its observations by October 26th 2018 in the form of a proposal report.

The commission will identify problems and practices that affect EsSalud services, and provide management guidelines as to how the provision of goods and services can be improved. The commission will have two officials from the MTPE, two representatives of EsSalud, two people from the National Labour Council and two from trade organisations.

EsSalud is Peru's social health insurance system, which provides five kinds of cover on a contributory basis. Regular insurance covers employees in registered companies and their families, as well as pensioners, while potestative insurance is available for the self-employed and other independent workers, and agricultural insurance covers farm-workers. In addition Peruvians can buy complementary insurance for those in risky occupations or accident insurance that covers them for death and disability. There is an alternative system, Seguro Integro de Salud (SIS), for those not covered by EsSalud. Some funding is also directed to separate healthcare schemes for the police and armed forces, as well as regional and local governments.

Under the 2009 Universal Health Insurance Law, it is mandatory for all Peruvians to take out insurance. However, according to the National Household Survey, only 84% of those aged above 60 years had some form of health insurance in the second quarter of 2018, a rise of 3.3% year on year. The government, led by Pedro Pablo Kuczynski, wants to achieve full coverage by 2021 by gradually introducing automatic enrolment via company records.

Service improvements

As well as gaps in enrolment, the health system also suffers from staff shortages and poor facilities, particularly outside the capital, Lima. Peru spends significantly less on healthcare than its regional neighbours, at an estimated 5.6% of GDP in 2017, well below the 7%-plus levels of Colombia, Chile and Brazil. In 2017 a widespread strike by health workers ended with them securing substantial pay rises. According to the National Superintendency of Customs and Tax Administration (SUNAT), monthly contributions to EsSalud reached Ns909.3m (US$273.5m) in August 2018, registering year on year growth of 10.1% in nominal terms.

The government has promised to lift investment in the public health sector from 2.2% of GDP to 4% of GDP. A programme of infrastructure renewal is also underway, helped by a substantial boost in 2018 government budget spending. In September, Fiorella Molinelli, the president of EsSalud, announced that the organisation was beginning a project to renew complex equipment and biomedical instruments in Peruvian hospitals.